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Test your knowledge on STEMI

Acute Coronary Syndromes (ACS)

1. In the appropriate clinical setting STEMI can be diagnosed based on all the criteria below, EXCEPT:

a. ST elevation of 1 mm in leads II, III, AVF (trend 3%)
b. ST elevation of 0.8 mm in V7-V9 (trend 34%)
c. ST elevation of 1 mm in V2-V3 in a 50 year old woman (trend 57%)
d. ST elevation of 2 mm in V2-V3 in a 45 year old man (trend 5%)

2. A 60 year old otherwise healthy man presents to a non PCI capable center with 2 hours of chest pain. Anterior STEMI is diagnosed. Transfer to a PCI capable center is possible, the estimated time to wire passage is 2.5 hours. The recommended approach is :

a. Thrombolysis and transfer to a PCI capable center if no signs of reperfusion are evident in 1 hour (trend 8%)
b. Thrombolysis and immediate transfer to a PCI capable center for angioplasty as soon as possible (trend 27%)
c. Transfer to a PCI capable center, no thrombolysis (trend 6%)
d. Thrombolysis and immediate transfer to a PCI capable center. Timing of angioplasty to be determined according to signs of reperfusion (trend 59%)

3. Which of the conditions below is NOT an absolute contraindication to thrombolysis?

a. Intracranial hemorrhage 10 years ago (trend 11%)
b. Ischemic stroke a year ago (trend69%)
c. GI bleeding 3 weeks ago (trend 3%)
d. Cholecystectomy 2 weeks ago (trend 17%)

This survey reflects current concepts about the management of STEMI among a large group of practicing cardiologists across Europe.

Question 1

deals with the diagnostic criteria for STEMI and the most common mistake is failing to recognize that ST elevation >0.5 mm in leads v7-V9 fulfills the criteria of the 3rd Universal definition for the diagnosis of STEMI.

Question 2

deals with reperfusion strategies in patients who do not have access to timely primary PCI. The great majority of responders correctly thought that since the projected time to wire passage exceeds 2 hours the patient should receive thrombolysis and be immediately transferred to a PCI capable center. The guidelines do state, however, that the timing of coronary angiography and PCI depend on the success of thrombolysis. If thrombolysis is judged to have failed then rescue PCI should be performed as soon as possible. If, however, there are signs of reperfusion when the patient reaches the PCI capable center PCI should be performed within 3-24 hours, not immediately.

Question 3

deals with contraindications to thrombolysis and, indeed, an ischemic stroke a year ago constitutes a relative, not absolute contraindication. The other conditions listed in the question are indeed absolute contraindications to lysis.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.